$411.11
Both describe closed treatment of a sternoclavicular dislocation. Use 23520 without manipulation and 23525 when the provider manipulates the joint.
On this page
CMS RVU26D · Effective 2026-10-01
23520 Sternoclavicular treatment Medicare reimbursement rates in Kentucky
Reports closed care of a sternoclavicular joint dislocation when the provider treats the injury without manipulating the joint to reduce it. Compare 23520 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 23520 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$249.19
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$227.81
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic treatment
About 23520: Closed sternoclavicular dislocation treatment without manipulation
Reports closed care of a sternoclavicular joint dislocation when the provider treats the injury without manipulating the joint to reduce it.
This code describes closed treatment of a dislocation where the clavicle meets the sternum, without manipulation of the joint. An orthopedic surgeon or other qualified treating provider may manage the injury with measures such as a sling, activity restrictions, and clinical follow-up. It applies to the sternoclavicular joint, not the acromioclavicular joint at the outer end of the clavicle. The code reflects definitive treatment, rather than simply identifying the injury during an evaluation.
Choose this code when the documented treatment is closed and no manipulation is performed; use the related with-manipulation code when the provider manipulates the joint. Documentation should identify the sternoclavicular dislocation and support the treatment approach. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 23520
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.23 · 28%
- Practice expense (office) RVU5.40 · 67%
- Malpractice RVU0.47 · 6%
11
Medicare services in 2024 · #6161 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
23520 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
23530 is for open treatment of a sternoclavicular dislocation; 23520 is closed treatment without manipulation.
$254.81
23540 treats a dislocation at the acromioclavicular joint, near the shoulder, rather than the sternoclavicular joint treated by 23520.
$237.89
23500 concerns closed treatment of a clavicular fracture. 23520 concerns a dislocation at the sternoclavicular joint.
Compare 23520 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$249.19
Facility
$227.81
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 23520 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
2,221
- Code
- 23520
- Physician work
- 2.23
- Practice expense
- 5.40
- Malpractice
- 0.47
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.23 | × 1.000 | 2.2300 |
| Practice expense | 5.40 | × 0.889 | 4.8006 |
| Malpractice | 0.47 | × 0.915 | 0.4300 |
| Total RVUs | 7.4606 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$249.19
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.23 | 1 |
| Practice expense | 5.4 | 0.889 |
| Malpractice | 0.47 | 0.915 |
(2.23 × 1 + 5.4 × 0.889 + 0.47 × 0.915) × $33.4009 = $249.19
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.23 | 1 |
| Practice expense | 4.68 | 0.889 |
| Malpractice | 0.47 | 0.915 |
(2.23 × 1 + 4.68 × 0.889 + 0.47 × 0.915) × $33.4009 = $227.81
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
23520 billing questions
When should 23520 be chosen instead of 23525?
Report 23520 when the sternoclavicular dislocation is treated closed without manipulation. Choose 23525 when the provider manipulates the joint as part of closed treatment.
How does 23520 differ from open treatment?
23520 describes closed treatment without manipulation. When the provider surgically treats the sternoclavicular dislocation, consider the applicable open-treatment code, such as 23530 or 23532.
What documentation supports reporting 23520?
Document the sternoclavicular joint dislocation, the closed treatment plan, and that the joint was not manipulated. Include the treatment provided, such as immobilization or activity restrictions, when applicable.
What is included in the global period?
CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
For bilateral treatment, CMS pays modifier 50 at 150%. The code's multiple-procedure reduction also applies when other procedures are performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,21823500,,Cltx clavicular fx w/o mnpj,A,,2.15,5.13,,4.74,,0.45,7.73,7.34,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,21923505,,Cltx clavicular fx w/mnpj,A,,3.73,7.70,,5.80,,0.81,12.24,10.34,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,22023515,,Optx clavicular fx w/int fix,A,,9.45,8.94,NA,8.94,,1.94,20.33,20.33,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,22123520,,Cltx strnclav dislc w/o mnpj,A,,2.23,5.40,,4.68,,0.47,8.10,7.38,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,22223525,,Cltx strnclav dislc w/mnpj,A,,3.70,8.87,,6.50,,0.79,13.36,10.99,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,22323530,,Optx strnclav dislc aqt/chrn,A,,7.29,7.61,NA,7.61,,1.54,16.44,16.44,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,22423532,,Optx strclv dslc aq/chrn grf,A,,8.00,8.18,NA,8.18,,1.70,17.88,17.88,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631